Abstract
Introduction
In orthopaedics one of the most common complications is infection. The occurrence of a postoperative infection significantly increases the failure rate; both in the case of prosthetic and trauma surgery. Some patients despite a meticulous antiseptic procedures, a close monitoring of controls peri- and post-operative undergo the development of infection of the fixation devices with the risk of developing osteomyelitis. This risk is highly increased in the distal leg because of the known problems with blood supply and poor muscle coverage. The functionality of the affected segment is impaired, quoad fuctionem, with increased risk of amputation and sometimes with poor prognosis, quoad vitam. The therapeutic strategy proposed by our group is to treat an osteomyelitic site as a pseudo-tumor with a megaimplant following a ladder strategy driven by the NUSS classification. This work shows our experience with a developing system by Waldemar-LINK highlighting critical issues and preliminary results.
Objectives
The purpose of this study is to evaluate retrospectively the early outcome after the implantation of this megaprosthesis of the lower leg in infected post-traumatic bone defects and septic peri-device bone loss. We registered all the complications and infection recurrence.
Methods
Between January 2013 today we have developed this system following the chamber induction technique (C.I.T.).
We perform a 2 steps procedure: 1° step: resection, debridement, devices removal and bi-antibiotic spacer implantation; 2° step: spacer removal and megaprosthesis implantation.
Results
Our first 10 patients with lower leg septic critical size bone defect were post-traumatic, 3 have ended the C.I.T. procedure with good clinical result and return to function.
Conclusions
The background experience in orthopaedic oncology, has allowed to develop megaimplants to break the vicious cycle of osteomyelitis and restore an optimal performance of the affected segment. We can perform a one step procedure only when all the infected segment is entirely removed, in other partial resections is better to follow a two steps procedure. In the development of this project will be possible to connect to a Megasystem C; this system will then be able to replace from the hip to the foot in the most complex cases. We also concluded that this type of complex surgery must be performed in specialized centers where knowledge and technologies are present.
